Hello to all our friends,

A 50-year-old patient asked, “How can I stop my body from being hunched over as I get older?” This is one question I have heard over the last 40 years by patients, aging athletes, workout instructors, and personal trainers. Even many fanatic work-out patients are perplexed as to how to stop from becoming hunched over as they age. I have had ex-marines who were a bit bent over when they walked, ask me how this could have happened since they have worked out 5-6 days a week throughout their entire lives.

The easiest answer lies both in our lifestyles and approach to exercise. Part of the problem is our lifestyle of bending forward to work on computers, phones, etc. Where the head goes, the body will follow. Another part of the problem is that the common approach to exercise has failed to address the importance of antigravity muscles compared to gravity assisted muscles. In this letter, I will try my best to explain what I mean.

Most of us spend lots of time either sitting or bending forward daily. As a result, we are giving in to our gravity muscles. Our muscles then tighten in the bending positions. As a muscle, usually in the front of our body, is placed in a shortened position (even during sleep as in the fetal position), the muscles can tighten and lose their ability to stretch. Many of us like to bend over and feel this is a great stretch, and it is sometimes. However, to bend forward after sitting or working in a bent position all day is assisting in weakening our antigravity muscles and causing tightness in our gravity muscles. This means we are helping gravity pull us into a hunched position over time!

We need to change our thought process if we want to have a chance of having a long life of standing up straight without any assistance. Will sit-up exercises (alone) help anyone stand straight as they age? Absolutely not! Sit ups work on gravity muscles! Yes, that is correct. Antigravity muscle are those muscles that will bring you back up from the bent forward position. They are muscles that keep your knees from pointing in towards each other.

Unfortunately, we have been trained to perform, sit-ups, biceps curls, bench press, pull- ups, etc... These are great exercises but pull each one of us to bent over postures in our future. These exercises need to be balanced with anti-gravity exercises. As a matter of fact, too many sit-ups will, in most cases contribute to more back pain and problems in your future!

If you are interested in learning more about strengthening the antigravity muscle system in your body, please feel free to write or call. You can educate yourself on some adjustments which you could make to help you walk and stand more erect as you age. These changes will also help diminish the risk of more serious injuries in the future.

We are planning on making a brief educational video on this topic in the next two weeks. It will be on our webpage, www.McDonaldpt.com. Until next time, try to remember to look for ways to get stronger and healthier which will help you feel better about yourself. These positive feelings will carry over to those around you as well!

Enjoy the journey!

Fran McDonald President/CEO

Physical Therapy Guide to Trismus

Trismus is an inability to open the mouth or jaw. Trismus interferes with many daily activities—chewing, swallowing, talking, brushing teeth, and even breathing. The condition may be caused by dental problems, cancer and cancer treatment, surgery, trauma, or other factors. With correct intervention from a physical therapist, trismus can improve in time, and full jaw function may return.

What Is Trismus?

The term trismus describes several conditions that cause an inability to open the mouth or jaw. The most common cause of trismus is inflammation of the soft tissue of the mouth due to:

• An impacted molar.
• Wisdom tooth removal.
• Removal of the tonsils.

Less common causes of trismus include:

• Radiation therapy to the face and neck.
• Tetanus (lockjaw), an acute infection from bacteria that usually enter the body through a wound.
• Myositis (muscle inflammation).
• Jaw nerve damage.
• Scarring of the tissues around the jaw or tongue. This can develop after a long period of not moving the jaw.
• Muscle atrophy (wasting) that can occur after as little as three days of not opening the jaw.
• Poor oral hygiene.
• Tumors or cancer.
• Trauma to the jaw area.
• Diseases, such as lupus and scleroderma.

Trismus can occur suddenly in the first nine months after radiation near the jaw joint (temporomandibular joint). This joint is also referred to as the TMJ. After that time the risk still exists, but the tightness tends to develop more slowly. Radiation treatments done near the TMJ or the muscles involved in chewing increase the risk for trismus. The risk increases with higher radiation doses.

Trismus tends to improve slowly. Studies suggest treatment may take from three to 12 weeks. Early treatment is the best way to prevent more severe problems. Your physical therapist will personalize a treatment program to your specific condition. The goals of your physical therapy program will be to:

• Speed the healing process.
• Reduce tightness in the jaw area.
• Help restore normal jaw movement and the ability to chew.

Signs and Symptoms

Symptoms of trismus include:

• Increased jaw pain.
• Inability to open the jaw. This means you cannot fit three fingers (lined up vertically) into the front of your mouth between the top and bottom teeth.
• A spasm or “tight” feeling when trying to open your mouth.
• Difficulty chewing, talking, breathing, and brushing and flossing your teeth.

If you have trismus, you may be at risk for choking. Trouble with chewing your food could cause you to change your diet, and lead to less than adequate nutrition. Even moving food around in your mouth can be hard with trismus because the tongue also may lose some mobility.

Not using your TMJ may lead to wasting or shrinking of the muscles that move the jaw, and possible damage to the TMJ surfaces.

Your medical team may suggest additional treatments to complement your physical therapist’s treatment. Using mouth splints to help with stretching has been proven effective. Other possible options include Botox injections to relax tight muscles, laser treatment, and surgery.

How Can a Physical Therapist Help?

Your physical therapist can help restore the natural movement of your jaw and improve your daily function. Trismus tends to develop slowly. In some people, it progresses so slowly that they don't notice it until they can only open their mouths half-way. The sooner you see your physical therapist, the better. Treatment that begins before trismus progresses is likely to be more efficient and effective.

If you have trismus, your physical therapist will choose the right treatments to improve your jaw movement and relieve pain.

Improve your jaw movement. Your physical therapist may prescribe stretches and range-of-motion exercises for your jaw. They will personalize the frequency and intensity of movements to ensure your safety. Your physical therapist may recommend specific techniques, such as stretching or self-mobilization, to minimize your pain and restore function.

Physical therapists also use hands-on techniques (manual therapy) to gently increase movement. Hands-on therapy also can help to relieve pain in tissues and joints. Manual therapy offers immediate and long-term effects on jaw movement for radiation-related trismus.

Your physical therapist may guide you through special "low-load" strengthening exercises. These exercises will avoid putting too much pressure on your TMJ. They can help you strengthen the muscles of the jaw to restore more natural, pain-free movement. Your physical therapist also may teach you gentle exercises that you can do at home to help you steadily improve your jaw function.

Relieve your pain. If your pain is severe, your physical therapist may apply treatments to reduce pain and improve motion. These may include electrical stimulation or deep heating. Physical therapists are experts at designing pain treatment programs that lessen the need for medication, including opioids.

* from choosept.com